ABSTRACT
BACKGROUND: The impact of the COVID-19 pandemic on Advanced Practice Registered Nurse (APRN) practice is not well known. PURPOSE: This study aimed to describe state practice barriers and explore the effects of the COVID-19 pandemic on APRN practice. METHODS: A descriptive study design used a 20-item web-based survey open from June 1 through September 23, 2020. FINDINGS: A total of 7,467 APRNs responded from all 50 states, including nurse practitioners (n = 6,478, 86.8%), certified registered nurse anesthetists (n = 592, 7.9%), certified nurse-midwives (n = 278, 3.7%), and clinical nurse specialists (n = 242, 3.2%). A number of barriers to practice prior to the pandemic were identified. Most respondents (n = 6334, 84.8%) identified that practice barriers limited the ability of APRNs to provide care during the pandemic. DISCUSSION: Barriers to APRN practice continue to restrict aspects of patient care and patient access to care, even in states with Full Practice Authority (FPA), during the COVID-19 pandemic and with state executive orders waiving practice restrictions. The study findings can be used to advocate for policy changes to support APRN practice authority.
Subject(s)
Advanced Practice Nursing/organization & administration , COVID-19/epidemiology , Practice Patterns, Nurses'/organization & administration , COVID-19/prevention & control , COVID-19/transmission , Female , Humans , Infection Control , Male , Nurse's Role , Surveys and Questionnaires , United StatesABSTRACT
BACKGROUND: While optimal utilization of the nurse practitioner (NP) workforce is an increasingly popular proposal to alleviate the growing primary care shortage, federal, state, and organizational scope of practice policies inhibit NPs from practicing to the full extent of their license and training. In March of 2020, NP state-specific supervisory requirements were temporarily waived to meet the demands of the coronavirus disease 2019 (COVID-19) pandemic in Massachusetts. OBJECTIVE: The objective of this study was to examine the impact of temporarily waived state practice restrictions on NP perception of care delivery during the initial surge of the COVID-19 pandemic in Massachusetts. RESEARCH DESIGN: Mixed methods descriptive analysis of a web-based survey of Massachusetts NPs (N=391), conducted in May and June 2020. RESULTS: The vast majority (75%) of NPs believed the temporary removal of practice restriction did not perceptibly improve clinical work. Psychiatric mental health NPs were significantly more likely than other NP specialties to believe the waiver improved clinical work (odds ratio=6.68, P=0.001). NPs that experienced an increase in working hours during the pandemic surge were also more likely to report a positive effect of the waiver (odds ratio=2.56, P=0.000). CONCLUSIONS: Temporary removal of state-level practice barriers alone is not sufficient to achieve immediate full scope of practice for NPs. The successful implementation of modernized scope of practice laws may require a collective effort to revise organizational and payer policies accordingly.
Subject(s)
COVID-19/therapy , Nurse Practitioners/organization & administration , Pandemics/prevention & control , Practice Patterns, Nurses'/organization & administration , Primary Health Care/organization & administration , COVID-19/diagnosis , COVID-19/epidemiology , Certification , Health Plan Implementation , Humans , Licensure , Massachusetts/epidemiology , Nurse Practitioners/legislation & jurisprudence , Practice Patterns, Nurses'/legislation & jurisprudence , Primary Health Care/legislation & jurisprudence , Professional Autonomy , Surveys and Questionnaires/statistics & numerical data , Workforce/legislation & jurisprudence , Workforce/organization & administrationABSTRACT
We describe rapid spread of multidrug-resistant gram-negative bacteria among patients in dedicated coronavirus disease care units in a hospital in Maryland, USA, during May-June 2020. Critical illness, high antibiotic use, double occupancy of single rooms, and modified infection prevention practices were key contributing factors. Surveillance culturing aided in outbreak recognition and control.
Subject(s)
Anti-Bacterial Agents , COVID-19 , Critical Illness , Gram-Negative Bacteria , Infection Control , Practice Patterns, Nurses' , Superinfection , Anti-Bacterial Agents/classification , Anti-Bacterial Agents/therapeutic use , COVID-19/epidemiology , COVID-19/physiopathology , COVID-19/therapy , Critical Illness/epidemiology , Critical Illness/therapy , Drug Resistance, Multiple, Bacterial , Gram-Negative Bacteria/classification , Gram-Negative Bacteria/drug effects , Gram-Negative Bacteria/isolation & purification , Humans , Infection Control/methods , Infection Control/organization & administration , Intensive Care Units/organization & administration , Maryland/epidemiology , Microbiological Techniques/methods , Microbiological Techniques/statistics & numerical data , Practice Patterns, Nurses'/organization & administration , Practice Patterns, Nurses'/standards , Precipitating Factors , Risk Factors , SARS-CoV-2 , Superinfection/diagnosis , Superinfection/microbiologyABSTRACT
BACKGROUND: Providing health care at a distance has evolved over the past decades, resulting in a myriad of terms and styles of care delivery. Telehealth is defined as any health care service delivered at a distance. Nursing services have been delivered by a wide range of specialty nurses for many years using various technological formats. Clinical experience suggests that few WOC nurses had extensively adopted these technologies and principles into their practice as recently as 2019. However, the COVID-19 pandemic of 2020 has forced both administrators and clinicians to rapidly adapt or introduce telemedicine technologies to deliver specialty care including WOC nurse services. CASES: Three WOC nurses were chosen to describe the use of telehealth technologies to illustrate opportunities for WOC nurses to integrate telehealth nursing into a health care setting. Two adapted telehealth technology into their practice before the pandemic, and one started telehealth practice as a means to provide care after the onset of the pandemic. Disadvantages and advantages are discussed to provide further information regarding WOC patient care using these technologies. CONCLUSION: The pandemic crisis has accelerated the need for health care to reimagine the delivery of care to patients. Telehealth technologies and principles have emerged as essential for WOC nurses to deliver safe and effective care.